Provider Demographics
NPI:1669679379
Name:MORENO, MONICA PATRICIA (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:PATRICIA
Last Name:MORENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MONICA
Other - Middle Name:P
Other - Last Name:MORENO DAZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1980 N ARTESIA DR
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-6365
Mailing Address - Country:US
Mailing Address - Phone:305-299-8153
Mailing Address - Fax:
Practice Address - Street 1:346 E 600 S
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3949
Practice Address - Country:US
Practice Address - Phone:435-251-2888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96209207RE0101X, 207RG0300X
UT79057551205207RE0101X, 207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine